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   Table of Contents      
COMMENTARY
Year : 2018  |  Volume : 66  |  Issue : 8  |  Page : 1143

Commentary: Evolution of Vitrectomy as Day Care Procedure


Professor & Head VitreoRetina, Minto Regional Institute of Ophthalmology, Bangalore Medical College & Research Institute, Bengaluru, Karnataka, India

Date of Web Publication23-Jul-2018

Correspondence Address:
Dr. Kalpana Nagaraj Badami
Professor & Head VitreoRetina, Minto Regional Institute of Ophthalmology, Bangalore Medical College & Research Institute, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1098_18

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How to cite this article:
Badami KN. Commentary: Evolution of Vitrectomy as Day Care Procedure. Indian J Ophthalmol 2018;66:1143

How to cite this URL:
Badami KN. Commentary: Evolution of Vitrectomy as Day Care Procedure. Indian J Ophthalmol [serial online] 2018 [cited 2019 Aug 20];66:1143. Available from: http://www.ijo.in/text.asp?2018/66/8/1143/237305



Journey of vitrectomy started with Robert Machemer in 1971 who introduced vitrectomy with single port VISC (Vacuum, infusion, suction, and cutting). Subsequently, infusion, illumination, and cutter were separated by O Malley and Heinz who developed the first three port 20-G (0.9 mm) vitrectomy system in 1974. Size of the Machemer vitrectomy port was 17 G (1.42 mm). However, vitrectomy in pediatric age groups was a concern, and hence, the port size was further reduced to 25 G (0.57 mm) in 2002. With introduction of minimum invasive vitrectomy surgeries (MIVS) 23 G, 25 G, and 27 G, vitrectomy became sutureless, minimized inflammation, and reduced surgical time with good visual recovery.[1],[2],[3]

Then came the idea of minimizing trauma due to regional anesthesia and its dreaded complications.[4] 27-G trocar cannula produces very minimal pain under topical anesthesia with and without sedation where surgical time was reduced by 10–20 minutes. In cases such as endophthalmitis, vitreous hemorrhage, vitreous floaters, epiretinal membrane removal, and macular hole, 27 G and topical anesthesia [3],[4] have been tried successfully. TrojanHorse anesthesia,[5] a novel idea of combining topical anesthesia with intracameral anesthesia for better patient comfort is preferred.

Then came the evolution in vitrectomy machines where sturdy equipments were replaced with lighter and compact machines. Innovation in cutters, electrical, and pneumatic cutters with high cut rate was possible even with this mobile, lighter, OPD-based vitrectomy machines. Hence, the idea of performing vitrectomies as office-based procedures under topical anesthesia evolved. Patients were comfortable and also psychologically the fear factor was reduced as it is done in minor operating theatre (OT). Results were good and there were no perioperative complications.

In developing countries like India where cost effectiveness is a concern, vitrectomies as office-based procedures under topical anesthesia should be highly beneficial. This results in reduction of OT time, minimizing cost and also complications but absolutely good visual recovery. Thus, vitrectomy could be a day care procedure in the near future and authors have described it well.



 
  References Top

1.
McClintock M, Rezaei K. Recent advances in vitreoretinal surgery. In: Review of Ophthalmology, 2015. Available at: https://www.reviewofophthalmology.com/CMSDocuments/2015/1/rp0115i.pdf. [Last accessed on 2018 Jul 16].  Back to cited text no. 1
    
2.
Mohamed S, Claes C, Tsang CW. Review of small gauge vitrectomy, progress and innovations. J Ophthalmol 2017;2017:6285869.  Back to cited text no. 2
    
3.
Warrier SK, Jain R, Gilhotra JS, Newland HS. Sutureless vitrectomy. Indian J Ophthalmol 2008;56:453-8.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Theocharis I, Alexandridou A. Sutureless 25G and 23G Vitrectomy Under Topical Anaesthesia. Invest Ophthalmol Vis Sci 2006;47:4657.  Back to cited text no. 4
    
5.
Gupta SK, Kumar A, Sharma A. Trojan Horse anaesthesia, a novel method of anaesthesia for pars plana vitrectomy. Oman J Ophthalmol 2018;11:119-23.  Back to cited text no. 5
[PUBMED]  [Full text]  




 

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